Clinical assessment of Tourette syndrome and tic disorders

doi:10.1016/j.neubiorev.2012.11.013

Neuroscience & Biobehavioral Reviews

Volume 37, Issue 6, July 2013, Pages 997-1007

https://doi.org/10.1016/j.neubiorev.2012.11.013 Get rights and content

Abstract

Tourette syndrome (TS) is a neuropsychiatric disorder involving multiple motor and phonic tics. Tics, which usually begin between the ages of 6 and 8, are sudden, rapid, stereotyped, and apparently purposeless movements or sounds that involve discrete muscle groups. Individuals with TS experience a variety of different sensory phenomena, including premonitory urges prior to tics and somatic hypersensitivity due to impaired sensorimotor gating. In addition to other conditions, stress, anxiety, fatigue, or other heightened emotional states tend to exacerbate tics, while relaxation, playing sports, and focused concentration on a specific task tend to alleviate tic symptoms. Ninety percent of children with TS also have comorbid conditions, such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), or an impulse control disorder. These disorders often cause more problems for the child both at home and at school than tics do alone. Proper diagnosis and treatment of TS involves appropriate evaluation and recognition, not only of tics, but also of these associated conditions.

Highlights

► Proper Tourette syndrome assessment must include evaluation of common comorbidities. ► Most patients with Tourette syndrome experience premonitory urges prior to tics. ► Rating scales exist to measure severity of tics and associated sensory phenomena. ► Most children with Tourette syndrome improve during adolescence and early adulthood.

Introduction

Tourette syndrome (TS) was first described by the French neurologist, Gilles de la Tourette, in 1885 as a “maladie des tics.” In his original case series describing the syndrome that now bears his name, Gilles de la Tourette wrote about many of the characteristics of the syndrome including: involuntary movements and sounds, markedly enhanced startle reactions, a tendency to repeat both vocalizations (echolalia) and movements (echopraxia), and uncontrollable verbal obscenities (coprolalia) (Lajonchere et al., 1996). Since then, our knowledge of TS has progressed significantly, including advances in our understanding of tics, their surrounding sensory phenomena, and the central role that other co-occurring diseases, such as attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD), have on the overall clinical course of the disorder. This review will focus on our current understanding of the diagnosis, clinical characterization and assessment of tics as well as their clinical course. Other reviews will focus on the evidence-based treatment and neurobiology of tic disorders.

Section snippets

Definition of tics

Tics appear as sudden, rapid, purposeless motor movements or sounds that involve discrete muscle groups. They are also stereotyped in that they will occur in a similar manner each time they are performed. In comparison to some movement disorders or psychiatric conditions (e.g. sterotypies, chorea, or dyskinesia), patients with tics report the ability to suppress them, even if only for a short duration. However, they report that suppression often causes discomfort. Almost any movement, sound, or

Tourette syndrome and other tic disorders

The prevalence of TS varies based on study design and location. An international prevalence of 0.6–1% has been reported for mainstream schoolchildren, with the disorder being 3–4 times more common in males than in females (Cavanna and Termine, 2012). Data from the 2007 National Survey of Children's Health (NSCH) showed an estimated prevalence of 0.3% among U.S. children aged 6–17 years (Scahill et al., 2009). This number may represent an underestimate of TS prevalence since data were gathered

Characterization of tics

Tics are characterized by their anatomical location, number, frequency, and duration. They are also further described by their forcefulness or intensity and by their complexity (ranging from simple to complex). The most widely-used rating scale of tic severity is the Yale Global Tic Severity Scale (YGTSS), which includes separate scores from 0 to 5 for number, frequency, intensity, complexity, and interference (the degree to which planned actions or speech are interrupted by tics) of both motor

Natural history

The natural history of TS has been established based on clinical observations. There is a clear progression of the disorder from the onset of symptoms to, in most cases, full or partial regression of symptoms. Tics usually begin around 6–8 years of age, and 90–95% of TS cases have an onset of tics between the ages of 4 and 13 (Leckman et al., 1998). Simple motor tics involving the eyes or face are usually the first to appear in a child with TS. They are called simple because they involve a

Sensory phenomena surrounding tics

The outward manifestation of TS represents only a part of the symptomatology experienced by most of our patients. In 1980, Joseph Bliss, articulately described his careful observations from 35 years of self-study of the feelings and subjective events surrounding his own tics. Much of what he described became the basis for future research surrounding the sensory phenomena associated with tics. The term, “sensory phenomena,” is now used as an all-encompassing term to describe such subjective

Exacerbating/alleviating factors

Tic symptoms vary in frequency and intensity, and in addition to potential neurological variation, it has been shown that certain environmental or contextual factors will either exacerbate or alleviate tic symptoms in individuals with TS.

The results of 6 different descriptive studies looking at the effects of different antecedent variables on tic severity show stress and anxiety appear to be the most common factors associated with an increase in TS symptoms, while fatigue and boredom also rank

Suppressing tics

One of the characteristics of tic symptoms is that they are suppressible, even if only for a short while. However, as stated earlier, the act of suppression can lead to the build-up of uncomfortable premonitory urges. In one study, 3 of 4 children who demonstrated reliable suppression showed a pattern of higher subjective urge ratings during suppression as compared to baseline (Himle et al., 2007).

Although tics can be suppressed, to do so requires more attention and energy from the individual.

Comorbidities

The description of behavioral and emotional disturbances in patients with TS has occurred since 1899, around the time the disorder was first described by Georges Gilles de la Tourette himself (Coffey and Park, 1997). In fact, comorbid neuropsychiatric disorders, the majority being ADHD and OCD, have been shown to occur in up to 90% of TS patients in both clinic and community settings (Wright et al., 2012). Figure 2 depicts the time course of common comorbidities in relation to tic symptoms, as

Conclusions

Tourette's syndrome is a neuropsychiatric disorder characterized by multiple motor and vocal tics. However, for many individuals with TS, the tics are neither the most prominent nor distressing part of the disorder. In the majority of children with TS, tic symptoms diminish significantly during adolescence. Most individuals with TS experience associated sensory phenomena such as premonitory urges and somatic hypersensitivity that are often as distressing as the tics themselves. The majority of

Conflict of interest

The authors have no conflicts of interest to disclose.

Acknowledgements

The authors acknowledge the National Institute of Mental Health support of the Trichotillomania Learning Center (MHB), the Yale Child Study Center Research Training Program (MHB), the National Institutes of Health (K23MH091240 (MHB), T32MH018268-26 (JFL) and R25 MH077823 (JFL)), the APIRE/Eli Lilly Psychiatric Research Fellowship (MHB), the AACAP/Eli Lilly Junior Investigator Award (MHB), NARSAD (MHB), and UL1 RR024139 from the National Center for Research Resources, a component of the National

References (91)

L.C. Baldan Ramsey et al.
Lesions of the dorsomedial striatum disrupt prepulse inhibition
Neuroscience
(2011)
M.H. Bloch et al.
Meta-analysis: treatment of attention-deficit/hyperactivity disorder in children with comorbid tic disorders
Journal of the American Academy of Child and Adolescent Psychiatry
(2009)
C.L. Budman et al.
Clinical phenomenology of episodic rage in children with Tourette syndrome
Journal of Psychosomatic Research
(2003)
P.B. Chappell et al.
Videotape tic counts in the assessment of Tourette's syndrome: stability, reliability, and validity
Journal of the American Academy of Child and Adolescent Psychiatry
(1994)
B.J. Coffey et al.
Behavioral and emotional aspects of Tourette syndrome
Neurologic Clinics
(1997)
C.A. Conelea et al.
Examining the impact of distraction on tic suppression in children and adolescents with Tourette syndrome
Behaviour Research & Therapy
(2008)
C.A. Conelea et al.
The influence of contextual factors on tic expression in Tourette's syndrome: a review
Journal of Psychosomatic Research
(2008)
C.A. Conelea et al.
The impact of a stress induction task on tic frequencies in youth with Tourette Syndrome
Behaviour Research & Therapy
(2011)
M.B. Himle et al.
An experimental evaluation of tic suppression and the tic rebound effect
Behaviour Research & Therapy
(2005)
M.B. Himle et al.
Investigating the effects of tic suppression on premonitory urge ratings in children and adolescents with Tourette's syndrome
Behaviour Research and Therapy
(2007)

J. Jankovic

Tourette syndrome. Phenomenology and classification of tics

Neurologic Clinics

(1997)

M.J. Kane

Premonitory urges as “attentional tics” in Tourette's syndrome

Journal of the American Academy of Child and Adolescent Psychiatry

(1994)

J.F. Leckman

Tourette's syndrome

Lancet

(2002)

J.F. Leckman et al.

The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity

Journal of the American Academy of Child and Adolescent Psychiatry

(1989)

A.B. Lewin et al.

Comparison of clinical features among youth with tic disorders, obsessive-compulsive disorder (OCD), and both conditions

Psychiatry Research

(2010)

J.S. March et al.

Tics moderate treatment outcome with sertraline but not cognitive-behavior therapy in pediatric obsessive-compulsive disorder

Biological Psychiatry

(2007)

Y. Nagai et al.

Influence of sympathetic autonomic arousal on tics: implications for a therapeutic behavioral intervention for Tourette syndrome

Journal of Psychosomatic Research

(2009)

S. Pliszka

Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder

Journal of the American Academy of Child and Adolescent Psychiatry

(2007)

M.M. Robertson

The prevalence and epidemiology of Gilles de la Tourette syndrome. Part 1: the epidemiological and prevalence studies

Journal of Psychosomatic Research

(2008)

M.M. Robertson

The prevalence and epidemiology of Gilles de la Tourette syndrome. Part 2: tentative explanations for differing prevalence figures in GTS, including the possible effects of psychopathology, aetiology, cultural differences, and differing phenotypes

Journal of Psychosomatic Research

(2008)

A.K. Shapiro et al.

Controlled study of pimozide vs. placebo in Tourette's syndrome

Journal of the American Academy of Child Psychiatry

(1984)

H.S. Singer et al.

Development of behavioral and emotional problems in Tourette syndrome

Pediatric Neurology

(1989)

D.G. Sukhodolsky et al.

Disruptive behavior in children with Tourette's syndrome: association with ADHD comorbidity, tic severity, and functional impairment

Journal of the American Academy of Child and Adolescent Psychiatry

(2003)

J.T. Walkup et al.

The validity of instruments measuring tic severity in Tourette's syndrome

Journal of the American Academy of Child and Adolescent Psychiatry

(1992)

T. Banaschewski et al.

Premonitory sensory phenomena and suppressibility of tics in Tourette syndrome: developmental aspects in children and adolescents

Developmental Medicine & Child Neurology

(2003)

H.N. Bawden et al.

Peer relationship problems in children with Tourette's disorder or diabetes mellitus

Journal of Child Psychology and Psychiatry and Allied Disciplines

(1998)

B.A. Belluscio et al.

Sensory sensitivity to external stimuli in Tourette syndrome patients

Movement Disorders

(2011)

B.A. Belluscio et al.

Similarities and differences between normal urges and the urge to tic

Cognitive Neuroscience

(2011)

J. Bliss

Sensory experiences of Gilles de la Tourette syndrome

Archives of General Psychiatry

(1980)

M.H. Bloch et al.

A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder

Molecular Psychiatry

(2006)

M.H. Bloch et al.

Caudate volumes in childhood predict symptom severity in adults with Tourette syndrome

Neurology

(2005)

M.H. Bloch et al.

Adulthood outcome of tic and obsessive-compulsive symptom severity in children with Tourette syndrome

Archives of Pediatrics and Adolescent Medicine

(2006)

M.H. Bloch et al.

Fine-motor skill deficits in childhood predict adulthood tic severity and global psychosocial functioning in Tourette's syndrome

Journal of Child Psychology and Psychiatry and Allied Disciplines

(2006)

C.L. Budman et al.

Rage attacks in children and adolescents with Tourette's disorder: a pilot study

Journal of Clinical Psychiatry

(1998)

W.E. Bunney et al.

Structured Interview for Assessing Perceptual Anomalies (SIAPA)

Schizophrenia Bulletin

(1999)

A.S. Carter et al.

Social and emotional adjustment in children affected with Gilles de la Tourette's syndrome: associations with ADHD and family functioning. Attention deficit hyperactivity disorder

Journal of Child Psychology and Psychiatry and Allied Disciplines

(2000)

A.M. Catafau et al.

Relationship between cerebral perfusion in frontal-limbic-basal ganglia circuits and neuropsychologic impairment in patients with subclinical hepatic encephalopathy

Journal of Nuclear Medicine

(2000)

A.E. Cavanna et al.

Tourette syndrome

Advances in Experimental Medicine & Biology

(2012)

A.J. Cohen et al.

Sensory phenomena associated with Gilles de la Tourette's syndrome

Journal of Clinical Psychiatry

(1992)

DSM-IV-TR

Diagnostic and statistical manual of mental disorders: DSM-IV-TR

(2000)

C.M. Eddy et al.

Clinical correlates of quality of life in Tourette syndrome

Movement Disorders

(2011)

R.D. Freeman

Tic disorders and ADHD: answers from a world-wide clinical dataset on Tourette syndrome

European Child and Adolescent Psychiatry

(2007)

R.D. Freeman et al.

Coprophenomena in Tourette syndrome

Developmental Medicine and Child Neurology

(2009)

W.P. Hetrick et al.

Phenomenological dimensions of sensory gating

Schizophrenia Bulletin

(2012)

M.B. Himle et al.

Establishing the feasibility of direct observation in the assessment of tics in children with chronic tic disorders

Journal of Applied Behavior Analysis

(2006)

Cited by (154)

Technologies for the management of hyperkinetic movement disorders
2024, Handbook of Digital Technologies in Movement Disorders
Hyperkinetic movement disorders (HMD) are characterized by abnormal involuntary movements of varying velocity, amplitude, frequency, complexity, and predictability. The integration of novel technological devices in the management of these diseases seems to offer a promising solution in providing more accurate and continuous monitoring. This chapter provides a critical overview of the available technological advances in the management of hyperkinetic disorders. For this purpose, a three folded approach was followed: (1) to present a brief overview of the technological advances in monitoring hyperkinetic disorders, (2) to provide a brief description of each HMD, how they are traditionally assessed, and an overview of the available devices, and (3) to discuss the implications for clinical practice and research.
Anxiety and Parenting Style in Children and Adolescents With Tic Disorders
2023, Pediatric Neurology
To study the associations of parenting styles and anxiety in Thai children and adolescents with tic disorders, comparing with healthy children and adolescents.
A cross-sectional study of children and adolescents aged between six and 18 years with tic disorders were enrolled. The control group comprised gender- and age-matched healthy children with no history of tic disorders. The Yale Global Tic Severity Scale was used to assess tics severity. All participants were evaluated for anxiety trait and state using the State-Trait Anxiety Inventory for Children (STAIC). The anxiety disorders were screened by using the Screen for Child Anxiety-Related Emotional Disorders questionnaire. Parenting styles were evaluated by the Parenting Styles and Dimensions Questionnaire.
A total of 41 children with tic disorders and 41 children in the control group were enrolled. According to the STAIC, the anxiety state and trait scores were significantly higher in the tic disorders group than in the control group (median [interquartile range]: 28 [13 to 31] vs 8 [6 to 10], P≤0.001, and 31 [18 to 36] vs 8 [3 to 11], P≤0.001, respectively). Furthermore, anxiety disorder was more frequently found in children with tic disorders than in controls (58.5% vs 17.1%, P≤0.001). There was no significant correlation between anxiety symptoms, parenting styles, and the severity of tics.
Anxiety is common in Thai children with tic disorders. Screening for anxiety in children and adolescents with tic disorders is essential, leading to early detection and providing proper management.
Comparative efficacy, tolerability, and acceptability of pharmacological interventions for the treatment of children, adolescents, and young adults with Tourette's syndrome: a systematic review and network meta-analysis
2023, The Lancet Child and Adolescent Health
In clinical practice guidelines there is no consensus about the medications that should be initially offered to children and young people with Tourette's syndrome. To provide a rigorous evidence base that could help guide decision making and guideline development, we aimed to compare the efficacy, tolerability, and acceptability of pharmacological interventions for Tourette's syndrome.
For this systematic review and network meta-analysis, we searched the Cochrane Central Register of Controlled Trials, Embase, PsycINFO, PubMed, Web of Science, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov, for published and unpublished studies from database inception to Nov 19, 2021. We included double-blind randomised controlled trials of any medication administered as a monotherapy for at least 1 week against another medication or placebo in children and adolescents (aged ≥4 years and ≤18 years), adults (>18 years), or both, diagnosed with Tourette's syndrome according to standardised criteria. We excluded studies that exclusively recruited participants with comorbid attention-deficit hyperactivity disorder or obsessive-compulsive disorder. The primary outcome was change in severity of tic symptoms (efficacy). Secondary outcomes were treatment discontinuations due to adverse events (tolerability) and for any reason (acceptability). Pharmacological interventions were examined considering medication categories and medications individually in separate analyses. Summary data were extracted and pooled with a random-effects network meta-analysis to calculate standardised mean differences for efficacy and odds ratios for tolerability and acceptability, with 95% CIs. The Confidence in Network Meta-Analysis (CINeMA) framework was used to assess the certainty of evidence. The protocol was pre-registered in PROSPERO (CRD42022296975).
Of the 12 088 records identified through the database search, 88 records representing 39 randomised controlled trials were included in the network meta-analysis; these 39 randomised controlled trials comprised 4578 participants (mean age 11·8 [SD 4·5] years; 3676 [80·8%] male participants) and evaluated 23 individual medications distributed across six medication categories. When considering medication categories, first-generation (standardised mean difference [SMD] –0·65 [95% CI –0·79 to –0·51]; low certainty of evidence) and second-generation (–0·71 [–0·88 to –0·54]; moderate certainty of evidence) antipsychotic drugs, as well as α-2 agonists (–0·21 [–0·39 to –0·03]; moderate certainty of evidence), were more efficacious than placebo. First-generation and second-generation antipsychotic drugs did not differ from each other (SMD 0·06 [95% CI –0·14 to 0·25]; low certainty of evidence). However, both first-generation (SMD 0·44 [95% CI 0·21 to 0·66]) and second-generation (0·49 [0·25 to 0·74]) antipsychotic drugs outperformed α-2 agonists, with moderate certainty of evidence. Similar findings were observed when individual medications were considered: aripiprazole (SMD –0·60 [95% CI –0·83 to –0·38]), haloperidol (–0·51 [–0·88 to –0·14]), olanzapine (–0·83 [–1·49 to –0·18]), pimozide (–0·48 [–0·84 to –0·12]), risperidone (–0·66 [–0·98 to –0·34]), and clonidine (–0·20 [–0·37 to –0·02]) all outperformed placebo, with moderate certainty of evidence. Antipsychotic medications did not differ from each other, but there was low to very low certainty of evidence for these comparisons. However, aripiprazole (SMD –0·40 [95% CI –0·69 to –0·12]) and risperidone (–0·46 [–0·82 to –0·11]) outperformed clonidine, with moderate certainty of evidence. Heterogeneity or inconsistency only emerged for a few comparisons. In terms of tolerability and acceptability, there were no relevant findings for any of the efficacious medication categories or individual medications against each other or placebo, but there was low to very low certainty of evidence associated with these comparisons.
Our analyses show that antipsychotic drugs are the most efficacious intervention for Tourette's syndrome, while α-2 agonists are also more efficacious than placebo and could be chosen by those who elect not to take antipsychotic drugs. Shared decision making about the degree of tic-related severity and distress or impairment, the trade-offs of efficacy and safety between antipsychotic drugs and α-2 agonists, and other highly relevant individual factors that could not be addressed in the present analysis, should guide the choice of medication for children and young people with Tourette's syndrome.
None.
Bilateral Globus Pallidus Externus Deep Brain Stimulation for the Treatment of Refractory Tourette Syndrome: An Open Clinical Trial
2023, Neuromodulation
We have previously proposed that Tourette syndrome (TS) is the clinical expression of the hyperactivity of globus pallidus externus (GPe) and various cortical areas. This study was designed to test this hypothesis by verifying the efficacy and safety of bilateral GPe deep brain stimulation (DBS) for treating refractory TS.
In this open clinical trial, 13 patients were operated on. Target coordinates (center of GPe) were obtained by direct visualization. Physiological mapping was performed with macrostimulation and microrecording. Primary and secondary outcome measures were, respectively, responder and improvement rates of TS and comorbidities, according to pre- and postoperative scores on the following assessment instruments: Yale Global Tic Severity Scale, Yale-Brown Obsessive Compulsive Scale, Beck Depression Inventory/Hamilton Depression Rating Scale, Beck Anxiety Inventory/Hamilton Anxiety Rating Scale, and Concentrated Attention test.
Intraoperative stimulation (100 Hz/5.0V) did not produce any adverse effects or impact on tics. Microrecording revealed bursting cells discharging synchronously with tics in the central part of the dorsal half of GPe. Patients were followed up for a mean of 61.46±48.50 months. Responder rates were 76.9%, 75%, 71.4%, 71.4%, and 85.7%, respectively, for TS, obsessive-compulsive disorder (OCD), depression, anxiety, and attention deficit hyperactivity disorder. Mean improvements among responders in TS, OCD, depression, and anxiety were 77.4%, 74.7%, 89%, and 84.8%, respectively. After starting stimulation, tic improvement was usually delayed, taking up to ten days to manifest. Afterward, it increased over time, usually reaching its maximum at approximately one year postoperatively. The best stimulation parameters were 2.3V to 3.0V, 90 to 120 μsec, and 100 to 150 Hz, and the most effective contacts were the two dorsal ones. Two complications were registered: reversible impairment of previous depression and transient unilateral bradykinesia.
Bilateral GPe-DBS proved to be low risk and quite effective for treating TS and comorbidities, ratifying the pathophysiological hypothesis that led to this study. Moreover, it compared favorably with DBS of other targets currently in use.
Potential relationship between Tourette syndrome and gut microbiome
2023, Jornal de Pediatria
In this article, the author aims to discuss and review the relationship between gut microbiota and Tourette syndrome, and whether the change in gut microbiota can affect the severity of Tourette syndrome.
Literature from PubMed, Google Scholar, and China National Knowledge Infrastructure was mainly reviewed. Both original studies and review articles were discussed. The articles were required to be published as of May 2022.
Current studies on the gut microbiome have found that the gut microbiome and brain seem to interact. It is named the brain-gut-axis. The relationship between the brain-gut axis and neurological and psychiatric disorders has been a topic of intense interest. Tourette syndrome is a chronic neurological disease that seriously affects the quality of life of children, and there appears to be an increase in Ruminococcaceae and Bacteroides in the gut of patients with Tourette syndrome. After clinical observation and animal experiments, there appear to be particular gut microbiota changes in Tourette syndrome. It provides a new possible idea for the treatment of Tourette syndrome. Probiotics and fecal microbial transplantation have been tried to treat Tourette syndrome, especially Tourette syndrome which is not sensitive to drugs, and some results have been achieved.
The relationship between gut microbiota and Tourette syndrome and how to alleviate Tourette syndrome by improving gut microbiota are new topics, more in-depth and larger sample size research is still needed.
Systematic Review and Meta-Analysis of Tourette Syndrome Prevalence; 1986 to 2022
2022, Pediatric Neurology
Tourette syndrome (TS) is a disorder characterized by a history of multiple motor tics and the emergence of at least one vocal tic during a period of the disorder. The current investigation sought to clarify the prevalence statistics for TS using a systematic review and meta-analysis.
This systematic review and meta-analysis covered the period between 1986 and 2022. Embase, Scopus, PubMed, Web of Science, and Google Scholar were searched to locate articles pertinent to the study topic. The I² index was used to examine the heterogeneity of the studies, and a comprehensive meta-analysis was employed to analyze the data.
Ultimately, 30 studies (39 outcomes) were included in the meta-analysis and systematic review. The results showed the global prevalence of TS to be 0.5% (95% confidence interval [CI], 0.3% to 0.8%), with the highest rate of spread observed in the Americas at 0.6% (95% CI, 0.2% to 1.6 %). Analyzing the subgroups of the sample revealed that the highest prevalence was associated with the population of children and adolescents at 0.7% (95% CI, 0.4% to 1.4%) and males at 0.5% (95% CI, 0.2% to 1.0%).
This comprehensive review and meta-analysis revealed that the prevalence of TS worldwide is sufficiently high, such that attention of medical specialists and health policy makers is warranted.

View all citing articles on Scopus

View full text

ReviewClinical assessment of Tourette syndrome and tic disorders

Abstract

Highlights

Introduction

Section snippets

Definition of tics

Tourette syndrome and other tic disorders

Characterization of tics

Natural history

Sensory phenomena surrounding tics

Exacerbating/alleviating factors

Suppressing tics

Comorbidities

Conclusions

Conflict of interest

Acknowledgements

Neuroscience

Journal of the American Academy of Child and Adolescent Psychiatry

Journal of Psychosomatic Research

Journal of the American Academy of Child and Adolescent Psychiatry

Neurologic Clinics

Behaviour Research & Therapy

Journal of Psychosomatic Research

Behaviour Research & Therapy

Behaviour Research & Therapy

Behaviour Research and Therapy

Neurologic Clinics

Journal of the American Academy of Child and Adolescent Psychiatry

Lancet

Journal of the American Academy of Child and Adolescent Psychiatry

Psychiatry Research

Biological Psychiatry

Journal of Psychosomatic Research

Journal of the American Academy of Child and Adolescent Psychiatry

Journal of Psychosomatic Research

Journal of Psychosomatic Research

Journal of the American Academy of Child Psychiatry

Pediatric Neurology

Journal of the American Academy of Child and Adolescent Psychiatry

Journal of the American Academy of Child and Adolescent Psychiatry

Premonitory sensory phenomena and suppressibility of tics in Tourette syndrome: developmental aspects in children and adolescents

Developmental Medicine & Child Neurology

Peer relationship problems in children with Tourette's disorder or diabetes mellitus

Journal of Child Psychology and Psychiatry and Allied Disciplines

Sensory sensitivity to external stimuli in Tourette syndrome patients

Movement Disorders

Similarities and differences between normal urges and the urge to tic

Cognitive Neuroscience

Sensory experiences of Gilles de la Tourette syndrome

Archives of General Psychiatry

A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder

Molecular Psychiatry

Caudate volumes in childhood predict symptom severity in adults with Tourette syndrome

Neurology

Adulthood outcome of tic and obsessive-compulsive symptom severity in children with Tourette syndrome

Archives of Pediatrics and Adolescent Medicine

Fine-motor skill deficits in childhood predict adulthood tic severity and global psychosocial functioning in Tourette's syndrome

Journal of Child Psychology and Psychiatry and Allied Disciplines

Rage attacks in children and adolescents with Tourette's disorder: a pilot study

Journal of Clinical Psychiatry

Structured Interview for Assessing Perceptual Anomalies (SIAPA)

Schizophrenia Bulletin

Social and emotional adjustment in children affected with Gilles de la Tourette's syndrome: associations with ADHD and family functioning. Attention deficit hyperactivity disorder

Journal of Child Psychology and Psychiatry and Allied Disciplines

Relationship between cerebral perfusion in frontal-limbic-basal ganglia circuits and neuropsychologic impairment in patients with subclinical hepatic encephalopathy

Journal of Nuclear Medicine

Tourette syndrome

Advances in Experimental Medicine & Biology

Sensory phenomena associated with Gilles de la Tourette's syndrome

Journal of Clinical Psychiatry

Diagnostic and statistical manual of mental disorders: DSM-IV-TR

Clinical correlates of quality of life in Tourette syndrome

Movement Disorders

Tic disorders and ADHD: answers from a world-wide clinical dataset on Tourette syndrome

European Child and Adolescent Psychiatry

Coprophenomena in Tourette syndrome

Developmental Medicine and Child Neurology

Phenomenological dimensions of sensory gating

Schizophrenia Bulletin

Establishing the feasibility of direct observation in the assessment of tics in children with chronic tic disorders

Review
Clinical assessment of Tourette syndrome and tic disorders